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Thirteen-year-old Jason comes to the clinic complaining of chest pain. Jason's younger brother has a heart murmur, and his dad's father died of a sudden heart attack at age 53. The pain started two weeks ago, although Jason just told his mother last night. Jason's mother is very concerned that it might be his heart causing the chest pain. Jason says the pain comes and goes, is worse when he coughs, is located on the left side of his chest, and does not radiate. Jason denies fever or cold symptoms, new activities in gym class, or weight lifting. He takes no routine medications and has taken nothing for chest pain. Jason has no other medical conditions. On physical examination, his vital signs are normal, his cardiac exam is normal, no murmurs, regular rhythm, and all pulses are equal. The rest of the exam is negative except for pain to palpation on the 4th to 6th ribs left of the sternum.
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